Scopoletin from Cirsium setidens Increases Melanin Synthesis via CREB Phosphorylation in B16F10 Cells

In this study, we isolated scopoletin from Cirsium setidens Nakai (Compositae) and tested its effects on melanogenesis. Scopoletin was not toxic to cells at concentrations less than 50 microM and increased melanin synthesis in a dose-dependent manner. As melanin synthesis increased, scopoletin stimulated the total tyrosinase activity, the rate-limiting enzyme of melanogenesis. In a cell-free system, however, scopoletin did not increase tyrosinase activity, indicating that scopoletin is not a direct activator of tyrosinase. Furthermore, Western blot analysis showed that scopoletin stimulated the production of microphthalmia-associated transcription factor (MITF) and tyrosinase expression via cAMP response element-binding protein (CREB) phosphorylation in a dose-dependent manner. Based on these results, preclinical and clinical studies are needed to assess the use of scopoletin for the treatment of vitiligo.

Validation of Termination Guidelines for Out of Hospital Cardiac Arrest in Korea

PURPOSE: There have been no studies on the termination of resuscitation (TOR) in Korea. We retrospectively applied TOR rules to OHCA patient data in order to validate the BLS and ALS TOR rules for Korea. METHODS: We collected OHCA (out-of-hospital cardiac arrest) data from 3 hospitals for the period January 1 to December 31, 2009. We then retrospectively applied BLS and ALS TOR rules to this data. We measured both the specificity and positive predictive value for each BLS and ALS TOR rule. RESULTS: The overall rate of survival until hospital discharge was 14.5%. Out of 102 patients who met BLS criteria TOR rules, 8 patients survived until hospital discharge. Out of 52 patients who met ALS criteria TOR rules, 4 patients survived until hospital discharge. The BLS rule had a specificity of 0.57 and a positive predictive value of 0.92. The ALS rule had a specificity of 0.78 and a positive predictive value of 0.92. CONCLUSION: In this study, the BLS and ALS TOR rules had relatively low positive predictive value and were not applicable to patients with low survival probability in Korea.

Estimation of the Rate of Preventable Deaths After Out-of-Hospital Cardiac Arrest: A Preliminary Study

PURPOSE: The wide range of survival rates after out-of-hospital cardiac arrest (OHCA) suggests that some deaths are preventable if an optimal emergency medical service (EMS) system is operated. The objective of this study was to propose a definition of preventable cardiac arrest death (PCAD) and to estimate the rate of PCAD in an area. METHODS: This was a prospective cohort study of OHCA patients in the Gangnam-gu area of Korea. We collected data for OHCA patients from January to December 2009. PCAD was defined as an arrest case who is expected to survive if the patient received optimal first aid from bystanders and EMS personnel. A consensus panel of three emergency physicians determined whether each event was preventable or not. The survivability of each event was calculated using formulas from previous studies. RESULTS: Among 104 arrests (an incidence of 18.3 per 100,000/year), 44 unexpected, non-traumatic arrests were analyzed. According to expert opinion, 16 of 30 (53%) who died within 24 hours after cardiac arrest were considered cases of PCAD. Survivability calculated using a previous formula was above 50% in 70% of patients. The Kappa value between the two estimations was only 0.247. CONCLUSION: The PCAD rate of Gangnam-gu area was estimated to be 53.3~70%. No bystander cardiopulmonary resuscitation, a delay in EMS activation, no use of an automated external defibrillator, or a delay in EMS arrival were considered problems in the process of pre-hospital care for sudden cardiac arrest.

Central Venous oxygen Saturation(ScvO2)Monitoring in Hemorrhagic Shock

An accurate and relatively simple method for estimating the amount of acute blood loss is essential in the hemorrhagic shock patients. Conventional physiologic parameters, blood pressure, pulse rate and CVP, could not serve for evaluation of the adequate oxygen transport in the tissue. Pulmonary artery catheter is a best tool for evaluating the cardiopulmonary function and the oxygen transport system, and mixed venous oxygen saturation(SvO2) monitoring have made a great advances for early detection of cardiovascular dysfunction and the changes in peripheral tissue oxygenation. But pulmonary artery catheterization is complicated procedure in emergency setting. Although the central venous oxygen saturation(ScvO2) cannot completely replace the SvO2 value, it has a close relation with SvO2 change in variable clinical situations. We testify the usefulness of ScvO2 monitoring in 24 patients of the hemorrhagic shock. Initial resuscitation was performed with ATLS standard and continuous ScvO2 was monitored. Systolic blood pressure and pulse rate were recorded for one hour from initial resuscitation in each 15 minutes. Nineteen patient was traumatic hemorrhagic shock and five was non traumatic. Twelve of 19 patients was blunt trauma, and remains were stab in injury mechanism. Mortality rate was 29.2%. Initial ScvO2 of nonsurvivor was 43.6%, and 51.3% in survivor groups(p>0.05). In the group of stab wound and non-traumatic hemorrhage, the ScvO2 was gradually increase by time. But ScvO2 in survivors of blunt trauma was increased first 30 minutes and decrease afterthen. Continuous monitoring of ScvO2 may by partly useful in resuscitation for hemorrhagic shock. It is more valuable in the blunt trauma than in the penetrating injury or non-traumatic hemorrhage.